IT AVAIL®LE COPY
MULTIPLE DEPENDENT CLAIM
FEE CALCULATION SHEET
(FOR VSS WrmF0BMPTO676)
APPLICANT(S) ^
CLAir
AS FILED
AFTER
1$t AMENDMENT
AFTER
2nd AMENDMENT
IND.
DEP.
IND.
DEP.
DEP.
IND.
DEP.
IND.
■ DEP.
IND.
DEP.
1
/
61
2
7 —
62
3
>
/
DO
4
/
64
5
55
6
56
7
-4-
67
3
-L-
58
Q
-i-
59
lU
(
cx\
ou
11
1
61
12
/
62
13
I
63
14
64
15
65
16
1
66
17
CO
Dl
18
J —
CO
oo
1Q
J.9
/
CO
' OA
70
21
71
79
iO
24
25
7K
26
76
oo
77
28
78
7Q
30
fin
ol
81
32
o^
oo
fi<l
oo
o^
OA
o*
oo
85
36
86
37
87
OQ
OO
oo
OQ
39
fiQ
09
Art
40
on
42
92
43
93
44
94
45
■X-
95
46
96
47
97
48
98
49
99
50
100
TOTAL
IND.
0
3
II
J
TOTAL
IND.
fl
. 0
TOTAL
DEP.
TOTAL
DEP.
mi
PTO-1360(3.78) mAY BS VSSD FOR ADDITIONAL GIMMS OR MSSNDSmm ^^^^^ffSm^h}^